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Notes Psychological Assessment Topic: Section: BS Psychology 3 Date: Reference: j Mental Status Examination (MSE) Mental Status is the total expression of a...

Notes Psychological Assessment Topic: Section: BS Psychology 3 Date: Reference: j Mental Status Examination (MSE) Mental Status is the total expression of a person’s emotional responses, mood, cognitive function, personality. Components: General appearance and behavior Speech Mood and affect Thought Perception Cognition (higher mental functions) Judgment Insight (GSM TP CJI) 1. General Appearance and Behavior a. General appearance Body build and physical appearance (approxi-mate height, weight, and appearance) Looks comfortable/uncomfortable Physical health Grooming Hygiene Self-care Dressing (adequate, appropriate) Facies (non-verbal expression of mood), b. Attitude towards the examiner Cooperation/guardedness/evasiveness/hostility Attentiveness Shows interest/appears disinterested c. Comprehension Intact/impaired (partially/fully) d. Gait and posture Normal or abnormal (way of sitting, standing, walking, lying) e. Motor activity lncreased/decreased Excitement/stupor Abnormal involuntary movements (AlMs) tics, tremors Restlessness/akathisia Catatonic signs (mannerisms, stereotypes, posturing, waxy flexibility, negativism, ambitendency, automatic obedience, echo-praxia, psychological-pillow) Conversion and dissociative signs (pseudo seizures, possession states) Social withdrawal, autism. Psychological pillow A sign of catatonia in which the patient holds her head a few centimeters above the bed or pillow. It is a symptom of catatonia and can last for many hours. f. Social manner Increased, decreased, or inappropriate. g. Rapport Whether a working empathic relationship can be established with the patient should be mentioned. h. Hallucinatory Behavior Smiling or crying without reason Muttering/talking to self (non-social speech) Odd gesturing in response to auditory or visual hallucinations. 2. Speech a. Rate and quantity of speech Whether speech is present or absent (mutism). If present, whether it is spontaneous. Productivity is increased or decreased. Rate is rapid or slow. Pressure of speech or poverty of speech. **How to identify or describe ‘normal speech’? - Rate of speech depends on culture and cultural adaptations - Asian - slow with accent - American - fast b. Volume and tone of speech Increased/decreased c. Flow and rhythm of speech Smooth/hesitant Dysprosody Blocking (sudden) Circumstantiality Tangentiality, loosening of associations. Verbigeration, Perseveration stereotypies (verbal) Flight of ideas, clang associations. Loosening of association Bonus: Content If nonsense (too much or too little info), may be mentally unstable. too much info Content, especially non coherence may give clues about the ID (unconscious) - Hysteria - Manifestation of hysteria can be represented by traumatic memories of the individual (i.e., physical, laughing with no reason, nonchalant) - Connection of hysteria to speech: - Speech reveals thoughts - A suicidal person may not speak and stay away from people as they are drowning in negative thoughts and they just want everything to stop. - Someone who is psychologically incapable/with disorder may have a presence of mutism. - If total mutism, MEDICATION - Therapy will not work otherwise, if too severe. - Observe effects of meds to person and therapy from there. - No more “normal” once diagnosed; goal of therapy is self-help. - Psychiatrist → 10 days → Therapy → Treatment - Extra: - support group instead of therapy bc - mahal magpagamot (resources) - we all have libido - libido ends at menopause and andropause (80 yo) 3. Mood or Affect  Affect is an outward expression of person’s current feeling State. Mood is sustained Emotional State; Overall General mood. Extra: Emotion 24 hours normal emotion is 15 mins ○ one emotion at a time per situation. the rest is rationalizing. ○ everything is only dual. the nature of humanity based on naturalism, is dual. if mix both, is a mechanism. In addition to non-verbal mood observed, the patient is asked about the present ‘mood.’ This is recorded as subjective affect while the observed emotional change is described as objective affect. Mood is described as Relaxed, Happy, Anxious, Angry - Depressed, Hopeless, Hopeful, - Apathetic, Euphoric, Euthymic (Normal/EvenMood) - Elated, Irritable, Fearful, Silly Affect and Mood Affect: How do they appear to you? Mood: asks the patient directly how he/she feels.  Mood - melancholic Affect of melancholic - depression Mood - happy Affect - joy mood - fear affect - anxiety mood - gloomy affect - tearful choleric phlegmatic melancholic sanguine among four, positive is sanguine similar to big 5 OCEAN Examples Mood is described as general warmth, euphoria, elation, exaltation and ecstacy in mania. Anxious and restless in anxiety and depression; Sad, irritable, angry, and despair in depression; Shallow, blunted, indifferent, restricted, inappropriate and labile in schizophrenia. Anhedonia may occur in both schizophrenia and depression. Questions to ask about mood How do you generally feel most of the time?/ What’s your mood like? How would you say you feel generally – happy, sad, frightened, angry? Depressed Mood Irritable Mood  Blunt Affect Flat Affect (more severe) 4. Thought a. Stream and form of thought Stream and form of thoughts overlap with the examination of speech. Spontaneity, productivity, flight of ideas, poverty of content of speech, thought block Continuity of thought is assessed. Whether the thought processes are relevant to the questions asked. Any loosening of associations, tangentiality, circumstantiality, illogical thinking, perseveration, verbigeration is noted. NORMAL THOUGHTS ARE SPONTANEOUS – SOMETHING THAT IS CURRENTLY HAPPENING. (i.e., it is cold here) b. Content of thought Obsessions and contents of phobias; ideas and delusions of persecution, reference, grandeur, love, jealousy (infidelity_, guilt, nihilism, poverty. Hypochondriacal symptoms, hopelessness, helplessness, worthlessness, and suicide should be explored. Delusions of control, thought insertion, thought withdrawal, thought broadcasting, Neologisms  BONUS: content of thought is known through sharing should be observed according to pattern and consistency not certain = resistance answer all questions = no problem with thought ask easily understandable questions the goal, when you ask questions, it aims to know more about the client ○ where the thought is coming from, not only the intactness of thought ○ in MSE, the client is sharing may be a help to understand later on the effect of the assessment. Questions about thought form Do your thoughts seem faster than normal? Do you find you have lots and lots of different thoughts? Does your mind seem to be slowed down? Do you ever have the experience when your thoughts suddenly stop? Do you ever feel that your mind is suddenly wiped blank and you have no thoughts at all? Questions about delusions Do you ever feel that people are following you? Do you ever feel that people are seeking to harm you in some way? Do people spy on you? Has anything strange or unusual been going on? Is there anything special about yourself which makes you different from other people? Is there anything you can do which other people can’t? Do you think that somebody has put a spell on you? ○ Is a spirit/djinn/demon causing problems for you? Questions about thought insertion Do you ever have thoughts in your mind which are not your own? Does anything else use your mind to think with? Does anything put thoughts into your mind from outside? Where do those thoughts come from? Questions about thought withdrawal Does anything ever take your thoughts away? Does anything else use your mind to think with? Does anything else put thoughts into your mind from the outside? Where do those thoughts come frm? Questions about thought withdrawal Does anything ever take your thoughts away? Do you ever have your mind wiped blank? Does anything take thoughts out of your mind so that they’re not there anymore? Questions about thought broadcast Can other people tell what you are thinking? Do your thoughts ever go out of your own mind? Do your thoughts go out your mind to other people? Are your thoughts ever put on television or radio? Do your thoughts go out of your mind to somewhere else? 5. Perception a. Hallucinations: Auditory, visual, olfactory, gustatory, or tactile ○ Auditory hallucinations should be further enquired - what was heard - how many voices were heard - in which part of the day - male or female voices - how interpreted and whether second person or third person hallucinations (i.e., whether the voices are addressing the patient or are discussing in him in third person). Hallucination is sensation, not perception. ○ In schizophrenia, there is an altered sensation. ○ Sensation is first altered/damaged before perception. ○ GPT: This distinction is important: it's not that the person is misinterpreting real external stimuli (as with illusions), but rather they are experiencing entirely false sensory input. ○ The best recourse for hallucination is medication first. To lessen occurrence of hallucination until it stabilizes and normalizes. b. Illusions and misinterpretations Whether visual, auditory, or in other sensory fields; whether occur in clear consciousness or not. Illusion and delusions are perception. The person’s interpretation of illusions reveal a person’s associations, experiences, and traumas. ○ Kabayo = vice ganda ○ If positive interpretation on ambiguous stimuli, no bad experience at the forefront of one’s mind. PERCEPTION and interpretation is influenced by experience, learning, and awareness. c. Depersonalization and derealization. d. Somatic passivity phenomenon Strange sensations imposed by ‘somebody.’ e. Others Autoscopy, abnormal vestibular sensations, a sense of presence should be noted here. Delusion vs. Illusion vs. Hallucination Delusion - false belief Hallucination - false perception ○ Altering what is normally seen, felt, tasted ○ Someone is touching me behind my back ○ Seeing Russel in 1900s history book. ○ Types: Positive - sensing things that are not there Negative - omitting something that should be there Illusion - misperception or distortion of real external stimuli, rather than perceiving something that isn’t there. 6. Cognition or Neuropsychiatric Assessment a. Consciousness Conscious/confusion/clouding/delirium/stupor/coma Any disturbance of consciousness should be rated on Glasgow Coma Scale. b. Orientation Whether the patient is well-oriented to ○ time (time, date, day, month, year, season, time spent in hospital) ○ place (where is he, location, where does he stay) ○ person (his own name, can he identify people around him and their role in setting). c. Attention Is the attention easily aroused and sustained? Ask the patient to repeat digits forwards and backwards.  d. Concentration Can the patient concentrate? Ease of distractibility Ask to subtract serial sevens frm hundred (100-7 test), or serial threes from forty (40-3 test), or to count backwards frm 20, or enumerate the names of the months (or days of theweek) in the reverse order. Note down the answers and the time taken to perform the tests. e. Memory Immediate retention and recall (IR and R) Recent ○ How did the patient come to the room/hospital; ○ What he ate for dinner the day before or for breakfast the same morning. Remote ○ Ask for the date of marriage ○ name and birthdays of children ○ any other relevant questions from the person’s past. ○ Note any amnesia (anterograde/retrograde) ○ confabulation, if present. Questions to ask for memory Long-term memory: ○ Where did you live when you were growing up? ○ What was the name of the school you went to? Short-term memory: ○ What did you have for breakfast? ○ What did you do yesterday? f. Intelligence Ask questions about general information, keeping in mind the patient’s educational and social background, his experiences and interests e.g., ask about ○ the current and the past prime ministers and presidents of India ○ the capital of India ○ the name of the carious states Test for reading and writing. GIve simple tests of calculation. g. Abstract thinking Abstract thinking testing assesses patient’s concept formation. The methods used are: ○ Proverb testing: asking the meaning of simple proverbs. ○ SImilarities (and differences) between familiar objects like table and chair; banana and orange; dog and lion; eye and ear ○ Differences Similarities: ○ What do the following have in common? ○ Chair and desk? ○ Apple and pear? ○ Poem and statue? Proverbs: What do people mean when they say.....? ○ Don't cry over spilled milk ○ A rolling stone gathers no moss ○ When the cat's away the mice will play 7. Judgment Personal judgment Social judgment is observed during hospital stay and during the interview session.  Test judgment is assessed by asking the patient what he would do in certain test situations, like ‘a house on fair’, or ‘a man lying on the road’, or ‘a sealed, stamped, addressed envelope lying on a street’. Judgment is rated as Good/Intact/Normal or Poor/Impaired/Abnormal 8. Insight patient’s degree of awareness and understanding that they are ill. Levels of Insight Insight is rated on a 6-point scale from one to six these are questions/items. 1. Complete denial of illness 2. Slight awareness of being sick & needing help but denying it at the same time 3. Awareness of being sick but blaming it on others, on external factors, or on organic factors. 4. Awareness that illness is due to something unknown int he patient 5. Intellectual insight 6. True emotional insight (I am sick, but I am afraid that I’m going to die soon. 5 - very poor insight.) Why the Mental Status Examination (MSE) is Considered an Assessment The Mental Status Examination (MSE) is categorized as an assessment because it involves a structured observation process guided by a checklist or tool. Unlike standardized tests such as IQ, projective, or personality tests, the MSE relies heavily on direct observation and interpretation during its administration.  1. Observation as a Core Component Primary Mode of Evaluation: MSE is grounded in observation, making it distinct from other psychological tests. While standardized tests include observational elements during their administration, MSE prioritizes observation as the main method for understanding a patient’s state. Purpose of Observation: ○ Validates covert behaviors (hidden to the self). ○ Bridges the Johari Window's “unknown to self” quadrant, where unawareness is a significant aspect of the covert. ○ Observing behaviors helps clinicians uncover psychological states or traits that the patient might not consciously recognize. 2. Preliminary Role of MSE Initial Interview and Assessment: MSE often occurs implicitly during the first clinician-patient interaction. This is a simple q & a wherein the client does not know that this is an MSE. Simple Q&A sessions or observations during an initial interview already constitute an MSE. 10-Day Observation Rule: ○ In hospital settings, a 10-day observation period allows for a thorough assessment of behavioral changes. This period often focuses on evaluating medication effectiveness and behavioral improvements. ○ Facilities like Mandaluyong, Bataan, and Cavite provide free services, though resource constraints limit access, highlighting the need for better governmental funding for mental health services. --- Domains of MSE MSE assesses the following core domains, often intertwined with cognitive, emotional, and psychomotor functioning: 1. Cognitive Domain: Includes thought processes, memory, perception, and orientation. 2. Affective Domain: Encompasses mood, emotional states, and outward expressions of affect. 3. Psychomotor Domain: Observes physical movements, such as gestures, restlessness, or catatonia. *** These three domains together contribute to the totality of personality. --- Components of MSE 1. General Appearance Initial observations focus on physical presentation, as appearance often reflects health and grooming habits. Subcategories include: ○ Body build and physical appearance (e.g., height, weight, general comfort). ○ Grooming, hygiene, self-care, dressing (e.g., hair, fingernails, and dressing). ○ Facies: Non-verbal mood expressions. Example: Red clothing may suggest histrionic personality traits. Body odor or unkempt grooming may reflect trauma or stress. 2. Speech and Thought Speech: Observed for rate, tone, volume, and coherence. ○ Fast speech may indicate mania, but content is equally crucial. Incoherence often reflects unresolved unconscious issues. ○ Volume: Can range from too soft to too loud. ○ Tone: Reflects emotions. ○ Dysprosody: Atypical rhythm, accent, or speech pattern, often unique to individuals. Thought: ○ Evaluates stream (e.g., spontaneous, flight of ideas) and content (e.g., delusions, resistance). ○ Abnormalities in thought processes often hint at underlying conditions like ASD or schizophrenia. Thought and Speech Connection ○ Thought processes influence speech patterns and vice versa. ○ Speech issues can signal problems with thought.  Hysteria and Speech ○ Hysteria as a Manifestation of Trauma Hysteria is often linked to traumatic memories and may manifest physically or behaviorally. Example: Laughing without reason can be a form of hysteria, appearing nonchalant but reflecting internal turmoil. Suicidal tendencies and speech ○ Suicidal individuals often withdraw from social interaction and exhibit mutism, reflecting an overwhelming focus on negative thoughts and a desire to die. Mutism ○ Total Mutism: The absence of speech, commonly associated with severe psychological disorders. ○ Mutism represents a state of psychological shutdown, making communication and therapy nearly impossible. Treatment of Mutism 1. Medication as the First Step In cases of severe mutism or hysteria, medication is essential before initiating therapy. Medications stabilize the individual, addressing underlying biological factors. 2. Observation Period The effects of medication are closely monitored to assess improvement. Progress, such as the return of speech, indicates readiness for therapy. 3. Therapy After Stabilization Therapy is most effective after the individual has been stabilized through medication. Observations: ○ Children (2.5–3 years old): Early signs of autism or speech disorders. ○ Comorbidities in ASD: Autism Spectrum Disorder often co-occurs with other psychological conditions. 3. Mood and Affect Mood: Describes long-term emotional state (e.g., melancholic, happy). Affect: Outward expression influenced by mood or immediate situations (e.g., tearful for gloomy mood). Affect and mood are interconnected yet distinct: ○ Example: A person with a melancholic mood may exhibit a depressive affect. Mood vs. Affect ○ Mood: Fear → Affect: Anxiety ○ Mood: Melancholic → Affect: Depression  ○ Mood: Happy → Affect: Joy ○ Mood: Gloomy → Affect: Tearful Temperaments ○ Choleric ○ Phlegmatic ○ Melancholic ○ Sanguine (the only positive) Comparison to OCEAN. Emotions ○ Emotional State: Describes the current emotional condition. ○ Emotion: The outward expression of that state ○ Emotions typically last around 15 minutes. ○ Prolonged emotional states can last up to 24 hours. ○ Typically, only one emotion dominates per situation. ○ Other feelings may simply be rationalizations. 4. Thought Stream and Form of Thought: ○ Should be spontaneous and productive. ○ Example: “It’s cold in here” (responsive and relevant). Content of Thought: ○ Revealed through sharing patterns and consistency. ○ Resistance to answering = potential issues. ○ Overly cooperative responses = intact thought process. Thought broadcasting: Belief that one's thoughts are being transmitted to others. Thought blocking: Abrupt interruption or cessation of thought processes. Delusions, Illusions, Hallucinations a. Delusion false belief that is not grounded in reality. Examples: ○ Believing one is married to Prince Charles. ○ Thinking Julianne will become the president (unrealistic certainty of future events). Reality: We will graduate in 2 years (based on reality). b. Illusion A misperception of real stimuli, often causing confusion. Key Point: Illusions are not misinterpretations but are distortions of what is perceived. c. Hallucination A perception without external stimuli, altering what is normally seen, felt, tasted, or heard. Examples:  ○ Feeling someone touch you when no one is there. ○ Seeing Russel in a 1900s history book. Commonly related to schizophrenia. Types: ○ Positive hallucinations: Seeing things that are not there ○ Negative hallucinations: Omitting or failing to perceive things that are present. Focus on how patients perceive their environment, shaped by prior experiences. Hallucinations, illusions, and delusions are assessed here: ○ Hallucination: Perception without external stimuli (e.g., hearing voices). ○ Illusion: Misperception of real stimuli (e.g., confusing shadows for a person). ○ Delusion: False beliefs that lack grounding in reality. --- Integration of MSE Findings MSE findings provide signposts, not conclusions. For example, fast speech could signal mania, but it must be corroborated with content and coherence checks. Observation informs therapeutic strategies: ○ Severe Cases: Patients may require medication before initiating therapy to stabilize symptoms (e.g., mutism in severe depression). ○ Therapy Goal: Promote self-help and independence, supported by resources like therapy or peer groups when treatment costs are prohibitive. --- Quotes and Perspectives "No one can complete you except yourself." – Dr. Ruel Cajili Therapy aims to foster self-reliance while acknowledging that diagnosed conditions often persist, requiring ongoing management. MSE, therefore, is a dynamic and foundational assessment tool, offering critical insights for diagnosis and treatment planning. MONDAY, NOVEMBER 18, 2024 --- 5. PERCEPTION: Perception is shaped by experience, learning, and awareness. Hallucinations Hallucination is sensation, not perception. Illusion and delusion are related to perception. Sensation and perception affect each other. Key Characteristics of Hallucinations: 1. Altered Sensation: In hallucinations, what is truly altered is the sensation, not perception. In schizophrenia, there is an altered sensation, leading to hallucinations. 2. Senses Involved: Hallucinations can affect any of the five senses: a. Gustatory: Taste b. Auditory: Hearing c. Visual: Seeing d. Olfactory: Smell e. Tactile: Touch 3. Sixth Sense Misconception: Claims of a "sixth sense" (e.g., seeing or talking to non-existent beings) are not an actual extra sense but result from altered sensations in the five senses, creating a distorted reality. 4. Example – Anne of Green Gables: A young girl creates a fictional friend due to traumatic experiences (abuse and abandonment). She sees, talks to, and interacts with this "friend," a reflection of her altered sensation. Such hallucinations are not lies but an escape from reality due to a distorted perception caused by emotional pain.  Goal of Clinicians: Help clients face reality, as hallucinations often serve as a way to escape. 5. Management of Hallucinations: Medication is the first recourse to stabilize and reduce hallucinations. Future understanding in psychopharmacology will determine the best medication. Illusions and Misinterpretations Illusion: Misperception of real external stimuli. ○ Example: Seeing a hand and misinterpreting it as a symbol of worship or love. Validation of Interpretation: To determine if an interpretation is accurate, it is essential to validate it. Conditions and Perception: ○ Individuals with psychological conditions may interpret things differently due to their altered perception. ○ Repeated exposure to the same stimulus may yield consistent responses in healthy individuals but different interpretations in those with conditions. Depersonalization and Derealization Depersonalization: Feeling detached from oneself. Derealization: Feeling detached from reality. Extreme Avoidance of Trauma: Individuals may distance themselves from trauma by becoming detached or emotionally numb. Example: Asexuality – avoidance of sexual attraction or pleasure may stem from trauma.  Somatic Passivity Phenomenon Definition: Strange or passive sensations seemingly imposed by external forces. Examples: ○ ASMR videos, mukbang, or satisfying content. ○ Satisfaction from unusual stimuli like sound, touch, or sight (e.g., watching ingrown removal). Psychological parallel: Traumatic experiences are “pressed out” during therapy, similar to how physical tension is relieved in a massage. --- 6. Cognitive a. Consciousness Delirium: ○ A critical sign indicating something is seriously wrong. ○ Associated with hallucinations and delusions. ○ In terminal cases, it may signify approaching death ("sinusundo na"). ○ For normal individuals, altered consciousness occurs in daydreams and fantasies. ○ Glasglow Coma Scale ○ Sometimes person is conscious, but attention is not with you. b. Orientation Disorientation becomes significant in conditions like dementia. Example: The Notebook – a story about dementia and orientation problems. Severe disorientation may stem from trauma. Signs of disorientation = 70 years old (observed lapses in time) Which is why the super retirement age is at 65. c. Attention Normal attention increases with development but decreases with aging ("life is a cycle").  Distinction: ○ Attention: Time-focused. ○ Concentration: Task-focused. d. Memory Retention: Short-term memory. Retrieval: Long-term memory. Two Types of Immediate Retention: ○ Recent memory (still processing). ○ Remote memory (older, more impactful memories are retained and easier to remember). Trauma often makes certain memories more impactful and easier to recall e. Intelligence Cognitive Ability: Intelligence is not limited to IQ but includes the ability to solve problems and answer questions. f. Abstract Thinking Reflects deeper and more complex thought processes. 7. JUDGMENT Objective judgment is critical. Subjective interpretations are less reliable and often unhelpful for individuals with conditions. 8. INSIGHT Measured on a 6-point scale: - Complete denial of illness  - Slight awareness of being sick & needing help but denying it at the same time - Awareness of being sick but blaming it on others, on external factors, or on organic factors. - Awareness that illness is due to something unknown in the patient - Intellectual insight - True emotional insight (I am sick, but I am afraid that I’m going to die soon. 5 - very poor insight.) Intellectual Insight: Awareness of concepts based on facts. Emotional Insight: Understanding based on validation of feelings and emotions. --- Psychological Report Profiling Responsibilities After Assessment After conducting an assessment, you are responsible for writing a clear psychological report. The report should be concise and well-organized to communicate the findings accurately. Importance of a Clear Report Misinterpretation: If the report is unclear, it can lead to misunderstandings about the assessment. Lack of Integrity: Ambiguous reports may raise concerns about the professionalism and honesty of the assessment. Lack of Validity: A report that is unclear or poorly written can diminish the trust in the findings, especially in legal contexts. Consequence: A poorly written report may not be taken seriously by the court. --- Common Uses of Psychological Reports 1. Adoption Psychological reports are used by the DSWD and then elevated to the court for approval.  2. Annulment Psychological assessments are needed for psychological incapacity in annulment cases. In cases where the other party does not consent, the assessment is non-negotiable, especially since this is ordered by the State. Costs: Cheapest comprehensive assessment: PHP 4,000 Most comprehensive assessment: PHP 11,000-15,000 3. Inheritance Psychological reports may be used to prove that someone is no longer capable of making decisions (e.g., for elderly individuals). Example: ○ Case of a 90-year-old billionaire: If an elderly person cannot manage their finances and no one else can prove their incapacity, the government may take over the assets. ○ Importance of creating a will to avoid this scenario. ○ If a living spouse exists, assets typically go directly to them. --- Essential Characteristics of a Report 1. Clear and Clean: The report must be organized and easy to follow. 2. Integrity: Ensure honesty in presenting findings without distortion. 3. Validity: The report should be accurate, relevant, and credible. Is done through triangulation. Assess → Get Results → Triangulate results Triangulation: Validate results by gathering information (interviews) from multiple sources, such as: a. Support group (nuclear family) b. Primary Environment c. Secondary Environment (school, work, etc.) It's rare to immediately access the secondary environment, but it can provide additional insights. Why triangulation? ○ Weight of information from the interview would have an equal impact. --- Principles of Report Writing 1. Unbiased Avoid any bias in the report. Ensure the findings are based on objective observations. 2. Factual Ensure that all information presented is based on facts and evidence, not assumptions or interpretations. (PROPER DRAWING) –– Psychiatric History Taking & MSE Psychiatric History Purpose: Psychiatric history provides essential clinical information, helping to understand why the patient has their current condition. It is a clinical method used to gather important medical and personal information. ○ If MSE looks at the present, PH looks at the past. Not always required: Psychiatric history is not necessary for every assessment, but the Mental Status Examination (MSE) is always performed. Components of Psychiatric History I. Demographic Data: In MSE, demographics are generally not observed; as it focuses on current conditions. However, Psychiatric history provides information about the client over time, which can validate and enhance the diagnosis. ○ That’s why Psych history is done WITH MSE. If there are no prior psychiatric findings, signs or symptoms may still exist in records, offering insight into the root causes of the current condition. ○ Understanding the root cause is critical for diagnosis; some signs may not have been formally diagnosed but were observed or reported earlier. Demographics vs. Sociodemographics ○ Demographics: Refers to data about the individual alone, not their environment or community. ○ Sociodemographics: Includes data about the individual and their community/environment, such as family, locality, or census information. Used by social workers: Sociodemographics help to understand the environmental factors contributing to the client's condition. ○ For medical/clinical conditions, it is best to use the demographic profile.  Complete Name: Use pseudonyms for confidentiality unless otherwise specified. Real names are used in professional settings unless instructed by a supervisor. Age: Provide chronological age in years and months. Sex: Biological sex at birth (based on sexual organs). Marital Status: Single, single parent, widow (F) /widower (M), divorced, annulled, or with a partner. Religion: Document as the client states (e.g., Catholic, Christian), but ensure that the information is accurate (ask family if necessary and unstable). Occupation: What the client did before the condition started (including when work ended). This is part of the secondary environment that can affect a person’s mental health. Socioeconomic Status ○ (e.g., above average, below average). Indicate before and after the condition because they may be financed by their family now due to the condition. ○ In government mental health facilities (Mandaluyong, Cavite, Bataan Center for MH), the status may be lower; in private, it may be above or average. Current Address: Do not record their permanent address if they are not residing there (for monitoring purposes). Informant: The person who referred the client or someone who can provide more details about the client. The relationship’s degree (e.g., secondary support, primary support) can determine the quality of information provided. ○ If possible, always use primary support II. Chief Complaints/Present Complaints (List with Duration) Similar to Presenting Problem/Chief complaint/present complaint in MSE. When writing the report, use the client's own words as much as possible. ○ Sleepless x 3 weeks III. Present Psychiatric History/Nature of the Current Episode Onset: nature of current episode. 3 types of onset: 1) Acute: Felt within hours (e.g., headache, irritability). Not necessarily a disorder but might be a prelude to disorder. a sudden, rapid, or unanticipated development of a disease or its symptoms. 2) Subacute: Symptoms appear gradually in a few days. 3) Gradual: Develops over weeks.  Intensity must describe onset ○ Increasing sadness, gradual onset. Precipitating Factors: External factors that contribute to or aggravate the condition (e.g., lack of sleep, finances, support system). ○ In report, explain how these factors aggravate a person’s condition. History of Current Episode: How the symptoms developed or changed. If unclear, gather information from primary support (go to informant). Associated disturbance ○ Separate psychiatric and medical problems. ○ Medical and psychological issues related to the complaint (e.g., diabetes, high blood pressure). These can interact with the psychological symptoms. IV. Past Psychiatric History Request Previous Records: Obtain past psychiatric records for verification and continuity of care. ○ If records are denied, it can delay the assessment and treatment. ○ Part of our ethical duty to share information when it benefits the client’s welfare. Number of Episodes ○ Is this episode current or is this a relapse (possibly due to stopped medication)? ○ Include the causes, onset, duration, and progress of past episodes. This helps determine if the current condition is a relapse. 10 sessions can show progress in a disorder in a client. ○ Relapse: Can happen due to inability to sustain medication, lack of treatment continuity, or financial difficulties. Describe Relapse: Cognitive, emotional, and behavioral symptoms are often impacted. i.e., blank cognitive domain, unidentifiable mix of emotions, behavior uncontrolled ○ Treatment Details: Include medications, treatment outcomes, and precipitating factors. V. Past Medical History Includes significant medical conditions, especially those that might impact psychological health (e.g., history of anesthesia causing hallucinations or memory decline). Surgical History: Relevant surgeries that may impact mental health. VI. Family History  This is to understand genetic vs. environmental influences on the client’s condition. Genogram: Create a family tree extending up to the grandparents. ○ Includes mental health conditions within the family. ○ Trace Common Disorders: Identify patterns in the family for conditions like depression, anxiety, or schizophrenia. ○ If no official diagnosis, describe signs of disorders. VII. Personal History Prenatal History: Consider the mother’s health and stress during pregnancy. Natal History: Birth history (e.g., breech birth, complications). Milestones: Track developmental milestones, such as: ○ Delays or advances in milestones may indicate developmental issues (e.g., Autism Spectrum Disorder, Schizophrenia). ○ Seek developmental pediatrician input until 13 years old. ○ First: Hearing ○ Second: Taste ○ Third: Touch ○ Fourth: Vision Childhood Behavior ○ Analyze early personality, traits, and attitudes. ○ ○ Overcompensation for poverty in childhood Illness or Malnutrition: Document any illnesses or malnutrition during childhood.  Schooling: Information about schooling, academic performance, and teacher relationships. Growth can be blocked by school. Occupational History: Age of entering the workforce and relationships with colleagues, superiors, and subordinates. Sexual History: Ask about sexual health, puberty (menarche), nocturnal emissions, menopause, and knowledge of sex. ○ Proven by theory of Freud. ○ Menarche/nocturnal emission ○ Menopause/andropause ○ Marital History: Consider marital status and family dynamics (use a genogram if necessary). VIII. Premorbid Personality Before the Onset of Illness: How was the client before their condition developed? Compare with the current state to assess any significant personality changes. Key Areas: ○ Attitudes towards social, family, and sexual relationships. ○ Self-perception and self-esteem. ○ Hobbies and interests. ○ Fantasy life. ○ Reactions to stress and adversity. November 11, 2024 Chat GPT-organized: MSE as an Assessment Why is MSE considered an assessment? MSE includes a checklist, acting as a structured tool for assessment. MSE is primarily observational rather than based on a formal test, unlike IQ, projective, or personality tests, which often incorporate observations only as a supplementary component. Importance of Observation in MSE Observation is critical in test administration and contributes significantly to diagnosis. It helps validate covert behavior—aspects hidden from the individual, aligning with the Johari Window concept (unknown to self but observable by others). If a behavior is not hidden, the person is usually aware of and mindful of their actions. Unawareness often makes up the larger, covert aspect of behavior, highlighting the importance of MSE as a preliminary assessment. MSE in Initial Interaction Upon seeking help, patients usually undergo an initial Q&A session with the clinician, which can include a covert MSE assessment. 10-Day Rule in MSE In hospital settings, psychologically ill patients are often observed for 10 days to gauge the effects of medication. Facilities that provide mental health services in the Philippines (e.g., Mandaluyong, Bataan, Cavite) are overwhelmed due to limited government funding for mental health, and some services now require payment. Impact of Nutrition on Medication Lack of adequate nutrition may impair the effectiveness of medications. --- Domains of MSE (Plus One) 1. Cognitive 2. Affective 3. Psychomotor Emotional Response is a psychomotor reaction, while Emotion is the feeling itself. Personality is the combination of these three domains. --- Components of MSE Sensation and Perception: All components from 1-8 involve sensation and perception, which are influenced by one’s environment and experiences. General Appearance The way someone presents themselves is observed first. Social norms define "normalcy," and deviations may indicate abnormalities. Superficial features like appearance are noted, as they’re the first layer observed by others. Examples: Someone well-groomed may appear prepared. Appearance-related issues like body odor or poor grooming may result from trauma. --- Note-Taking for MSE What You See is What You Say: Describe observations directly, while being aware that interpretations can vary. For example, two people may describe the same person differently based on experience. Language for Family Explanation: Use simple, understandable terms when communicating findings to a client’s family. --- A. General Appearance in MSE Observations include: Comfort Level: Comfortable/uncomfortable (e.g., fidgeting) Physical Health: Visible signs of health (e.g., psoriasis, stress-related signs) Grooming: Attention to personal care (e.g., hair, nails) Dressing: Appropriateness and adequacy (e.g., color choice may reflect personality traits like histrionics) Hygiene: Cleanliness and self-care Grouping in Notes: Body Build & Physical Health: Approximate height, weight, and appearance. Comfort: Comfortable or uncomfortable behavior. Self-Care Group: Grooming, hygiene, dressing. Distinct Elements: Facies (non-verbal mood expression) and comfort level. – Original: MSE is considered an assessment. Why? Because There is a checklist for this, so there is a tool. Assessment - in MSE there is no similar test to what MSE is OBSERVATION in other tests, in iq, projectives, personality, there is always a counterpart observation while administering the tests. Observation is number 1 factor when talking about administration of test. What does it contribute in further diagnosis? Why observe? Helps in validation of COVERT behavior - hidden to SELF johari's window of the self unknown to self can be validated by others if not hidden, person is AWARE and mindful of action UNAWARENESS is the BIGGER PART. is COVERT COVERT it is important MSE should be the PRELIMINARY ASSESSMENT. When a patient seeks help, there is an initial interview with the clinician. A simple Q and A, without knowing that MSE has taken place alr Another way of MSE is 10 day rule. Basement - hospital with accommodate psychologically ill patients, so that the place cannot be harmful to them. Don't jump off. 10 days that patient to be observed in the hospital. The effect of medication is objectivized to be observed within 10 days. If not 10 days, 2 weeks. How behavior has changed in 10 days MSE. How many facilities does the Philippines have? Centers for MH Mandaluyong Bataan Cavite these provide free mental services for patients. due to fast rising cases, they can no longer accommodate, unless you pay for the services. our government does not allot budget to mental health. we also don't have nutrition. meds dont work due to no nutrition. DOMAINS OF MSE (plus 1) 1. cognitive, 2. affective, 3. psychomotor emotional response vs emotion emotional response - psychomotor personality - totality of 3 domains COMPONENTS ALL 1-8 are in SENSATION and PERCEPTION we perceive based on EXPERIENCE from environment General appeaerance - how you present yourself we cannot survive without others (social beings). A normal individual is socially interactive. Anything outside the context of envi, abnormal Extreme from range of normalcy is considdered ABNORMALITY. When one sees another, appearance comes first because appearance is SUPERFICIAL. Example, when dr. ruel asked 2 ppl what he looks like, they had varying answers. Anthony - beard/facial hair (appeaerance) JR - may deeper description na based on experience (well-groomed and prepared) The one who is well-groomed comes to class prepared. if body odor, no grooming Why does sometimes, people have that as an alteration of normal (BO is prepared)? they see diff things bc of trauma. when taking down notes for MSE, take note of the ff.: What you see is what you say. But sometimes someone has a different perception. The person does not automatically respond to the instruction. This part is simple, but it becomes complex due to analysis. Because to explain in family of client, use words that are KNOWLEDGEABLE, easily understood. A. GENERAL APPEARANCE comfortable/uncomf (fidgeting) Physical health (i.e., psoriasis) manifested physical health due to stress (eyebags, etc.) Grooming (hair, fingernails) part of grooming Dressing example puro red (histrionic personality) as one ages, the person's capability of exploring declines, particularly for females. Self-care if we're going to cluster different general appearance in MSE Body build and physical appearance (approxi-mate height, weight, and appearance) Looks comfortable/uncomfortable Physical health Grooming Hygiene Self-care Dressing (adequate, appropriate) Facies (non-verbal expression of mood), These are together: physical health body build phys health grooming, hygiene, self care, dressing distinct from others: facies, looks comfy